Oral Antibiotics for Treating Children With Community-Acquired Pneumonia Complicated by Empyema

Area of Science:

• Pediatric Pulmonology
• Infectious Diseases
• Clinical Therapeutics

Background:

• Community-acquired pneumonia complicated by empyema (CAP-Em) in children lacks a standardized management approach.
• Evaluating outpatient oral antibiotics versus parenteral antibiotics for CAP-Em is crucial for optimizing treatment strategies.

Purpose of the Study:

• To compare the effectiveness of outpatient oral antibiotics (O-Abx) versus inpatient parenteral antibiotics (OPAT) for children with CAP-Em post-discharge.
• To assess the utility of inflammatory markers (WBC, CRP, ESR) in guiding the duration of antibiotic treatment for CAP-Em.

Main Methods:

• Retrospective cohort study of pediatric patients diagnosed with CAP-Em between 2006 and 2016.
• Primary outcome: treatment success defined as no antibiotic change or readmission for CAP-Em.
• Serial measurements of white blood cell (WBC) count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were analyzed.

Main Results:

• Treatment success was significantly higher with O-Abx (92.4%) compared to OPAT (58%) (P = .0031).
• WBC and CRP levels decreased early during O-Abx treatment, indicating positive response.
• ESR showed an initial increase followed by a decrease, suggesting its role in monitoring treatment progression.

Conclusions:

• Outpatient oral antibiotics represent the preferred treatment modality for children with CAP-Em following hospital discharge.
• WBC and CRP are valuable for monitoring the success of switching to O-Abx.
• ESR can provide guidance on the appropriate length of antibiotic therapy for CAP-Em.